Arlington Department of Human Services



For more information:

Arlington County Department of Human Services

Environmental Health Bureau

(703) 228-7400

Demographics

Arlington County is an urban area of about 26 square miles that is situated across the Potomac River from the Nation’s capitol. Conveniently accessible by either public transportation or automobile, Arlington attracts a diverse residential and employment community. According to the 1990 Census, the racial composition for whites, blacks, Asian-Pacific Islanders, and other races were 76.6%, 10.5%, 6.8%, and 6.2%, respectively. Residents of Hispanic origin comprised 13.5% of the total population.

Arlington Department of Human Services

The Arlington Department of Human Services (ADHS), the facilitating agency in undertaking the PACE EH initiative, is an umbrella agency responsible for coordinating and supporting the delivery of services to 185,500 people. The ADHS employs approximately 188 full-time staff members and has an operating budget of $10,000,000.

ADHS is familiar with conducting community health assessments and fostering partnerships and thus has a tradition of involving community partners in program planning decisions. ADHS serves as a catalyst for regional cooperation in many areas, including enforcing food and swimming pool safety codes, performing a broad review of the overall human-services delivery systems in Arlington County, and designing interventions to protect the water supply for the Washington metropolitan area.

Beginning the PACE EH Process

One of the more difficult tasks undertaken before the PACE EH methodology could be employed was garnering internal agency support. Although not all local public health agencies are required to obtain official approval, in Arlington County, approval was needed from the County Manager before the process could commence.

Once approval was obtained, staffing needs were addressed. Although ADHS provided the majority of staff time and resources, outside assistance was also needed. For instance, a graduate student from George Washington University School of Public Health (GWU) was enlisted to work 20 hours per week with the project as part the MPH internship requirement. Faculty from GWU and Georgetown University School of Nursing were recruited to work on data analysis, and two staff members from the Department of Environmental Services dedicated about 10% of their time to the PACE EH process.

The Arlington CEHA Team

A community-based environmental health assessment (CEHA) Steering Committee of eight people was formed. This core group then solicited citizens and key agencies and organizations for participation on the CEHA team, making sure to have representation from minority and disenfranchised individuals. As a result, a full CEHA team (which included an additional 20 members) was established representing ADHS, George Washington and Georgetown Universities, League of Women Voters, United Way, Department of Public Works, Arlington Health Foundation, National Environmental Health Association, Phoenix House, Department of Environmental Quality, Virginia Environmental Health Association, and Department of Environmental Services.

Generating an Environmental Health Issue List

Arlington employed a survey as its data-gathering method to a) involve the community in the process of generating an environmental health issue list and b) determine the community perspective of the environmental health status of Arlington by surveying a reasonably representative sample. Two criteria were used to determine whether a particular issue was included on the questionnaire: whether it was an environmental health issue and whether the issue had directly impacted Arlington County. As a result, the following 17 environmental health issue categories were included in the survey:

|possible disasters |transportation accidents |

|unintentional injuries |construction |

|energy sources |noise |

|outdoor air pollution |indoor air pollution |

|commercially used hazardous materials |dangerous chemicals in home |

|inappropriate disposal |food safety |

|sanitary inspections |drinking-water contaminants |

|sanitary system |streams/storm-sewers/rivers |

|disease carriers | |

The CEHA team divided into two groups after the questionnaire was developed. One group volunteered to focus on community outreach, working with the community in disseminating and collecting the surveys. The other group was involved in the analysis of the results from the questionnaire and further data collection.

A pilot test of the draft questionnaire was conducted and distributed to the League of Women Voters and to a drug treatment center. The CEHA Steering Committee then identified the survey population as residents of Arlington County (people who worked in Arlington County and lived in another jurisdiction were excluded) to receive the final version of the survey. The survey was available in Spanish and English and administered in group settings. To reach a broad and diverse population, the questionnaire was administered to the following organizations and community members:

Targeted audiences

• WIC Program

• Service organizations (e.g., civic associations, Rotary Club, and the Civic Federation)

• Churches

• Senior centers

• Arlington Free Clinic

• Phoenix House

• League of Women Voters

• Teen Weight Lifting Club

Broad Community

• Jury pool

• Animal Welfare League

• T.J. Recreation Center

During the 2-month period the survey was administered, over 400 responses were obtained. The results from the survey were not intended to include strict statistical validity. Instead, they were juxtaposed with the scientific data to help ensure that identified strategies were on target. Although many environmental health concerns were identified upon evaluation of the survey results, the top four issues included outdoor air pollution, transportation accidents, disease carriers, and food safety.

Developing Indicators

Contrary to the PACE EH methodology, the CEHA team decided not to develop indicators until after data collection. With limited time and resources, the team ascertained that developing indicators supported by data was a more reasonable and effective approach than identifying indicators unsupported from the data gathered.

Indicators for food sanitation were developed after data were collected. The CEHA Steering Committee is currently developing indicators for the rodent-control program (e.g., food source and harborage).

Creating Issue Profiles

Once all survey administration was completed and the results tabulated, the CEHA Steering Committee decided to profile the issues, because a) doing so provides a basis for obtaining information through a survey tool and b) collecting scientific data can help narrow the issues to the top four or five. Issue profiles for 12 of the 17 environmental health categories were developed using a modified version of the profile tables from the PACE EH guidebook (see the following text box). However, 11 categories of the issue profiles were actually completed because there was some overlap between the construction and indoor air pollution categories.

Ranking and Prioritizing

Of the remaining 11 categories for which issue profiles were created, the CEHA team then made presentations regarding the environmental health data and survey results for each of the categories. Afterward, each CEHA Steering Committee member was tasked with assessing each issue as a high, medium, or low concern for environmental health in Arlington County. A “sticky dot” method of identifying the top four issues was then used. As a result of this process, outdoor air pollution, transportation accidents, food safety, and disease carriers were the four issues that emerged of greatest significance. Intervention strategies were then identified and proposals were discussed.

Current Status of the PACE EH Project

The health department is now in the process of implementing strategies that respond to the top four issues. Having selected “disease vectors” as one of its four priorities, the county moved the rat control program under the Environmental Health Bureau and chose last year to fund an arbovirus control program in response to concerns about West Nile Virus. Building on CEHA results the health department has received funding to implement a pedestrian safety program (responding to the transportation safety issue) and funding to develop a field experience for public health nurses in environmental health using food sanitation as a core experience for the nursing students.

In addition, in cooperation with the Police Department, Department of Public Works, and George Washington University School of Public Health, ADHS initiated a pedestrian safety study. That study was included in Arlington's Traffic Calming Plan.

For ADHS, a newly created connection with the community is the most important outcome of having implemented PACE EH. Not only does the Arlington community now better understand the field of environmental health, but also community members serve as strong advocates for health department programs.

Advice for future users

Focus groups were not used by ADHS because they are usually time consuming. However, for other communities that have substantial staffing resources, the use of focus groups could be beneficial. Once a list of environmental health issues has been created, the focus groups could be used to narrow down the list and identify the 5-10 greatest environmental health concerns.

PACE EH Tools and Materials Used by Arlington County

A. CEHA Steering Committee

B. CEHA Survey

C. PACE EH Profile Tools (included in profile)

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Information Included in the Profiles

• Geographic

How does this affect our community, relative to the following (e.g., region, neighborhood/zip code, and county)?

• Magnitude

How many people does it affect?

• Sensitive Populations

Who is affected (e.g., pregnant women, immunocompromised people, people with asthma, children, and elderly people)?

• Scientific Data

• Reason for Concern

Is the issue/risk associated with the following (e.g., high mortality rate, high morbidity rate, and reduced potential

life)?

• Trend

Is the condition or risk improving, staying the same, or worsening?

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